Rethinking Vulnerable Populations in the United States: An Introduction to a General Model of Vulnerability

The United States has experienced and, at times, promulgated a long history of inequality among its citizens. From civil rights violations and suffrage restrictions that only started to resolve in the past 60 years, to increasing income gaps between the poor and rich through the early 21st century, inequality continues to pervade many aspects of modern life including education, employment, housing and other life necessities. Most deeply affected have been groups delineated by race or ethnicity, socioeconomic status, immigration status, culture and language, and sexual orientation.1 Perhaps the most persistent manifestation of inequality has been an ongoing and, in some cases, increasing disparity in health and wellbeing across these social divisions. Today it is not considered surprising to see major health differences between whites and AfricanAmericans, the wealthy and poor, or the insured and uninsured. But perhaps it should be more surprising, considering that most health disparities are not caused by the lack of sanitation, poor drinking water, or famine that claimed the lives of many of this nation’s underprivileged in earlier years.2 Things, in fact, have changed dramatically. The causes of health disparities are not always obvious and, as we are starting to better understand, are rooted very deeply in the social context surrounding modern life.3 The medical professions are beginning to unravel and understand the impact that personal social position and social class, racism and discrimination, social networks, and other more relational community factors have on population health. Some of this knowledge has been applied to design interventions to address health disparities, but most efforts are in their infancy.4 Theory regarding vulnerable populations has dominated the social science and public health literature, but is